It is clear to all of us now that although the lockdown is helping to flatten the curve in India, we will continue to witness a surge of Covid 19 positive cases at all locations over the coming days/weeks. There is a strong necessity for us to be “prepared”.

For a campus-based academic/research institute, what does “preparedness” mean – making adequate arrangement for ‘General Advisory’, ‘Quarantine’, ‘Isolation’ and ‘Treatment of positive patients’.

General advisory : the purpose is to disseminate accurate information from time to time to the target population that are to be followed by everyone. The steps involved are –

1. Formation of a ‘Disaster Management Team’(DMT), headed by a senior official of the institute but comprising of the following members –Doctor with sufficient knowledge about such situations, Public health specialist (external, if not available within the institute), Security In-charge, Communications expert, 1 or 2 senior professors from Life-science/Health technologyrelated subjects or who are in the fore-front of related technology innovations.
2. Set up a ‘Call Centre’ with a dedicated number 24x7, to be the ONLY source for all information related to Covid 19.
3. ‘Nodal Reporting Authority’ (NRA)–the person/team to whom all information related to Covid 19 should be passed on to; and this person/team will co-ordinate with all external agencies involved eg. Hospitals, state government etc.
4. Ambulance/Transport team – 1 or 2 well-equipped ambulances are to be kept ready, with staff trained in case of evacuation necessities.

Quarantine : this is applicable to ALL who do not have any symptom of the disease, have no clinical complaint, are completely asymptomatic but have or may have exposed themselves to diagnosed/symptomatic person/s or environment/s with known instances of Covid 19 spread.

Detailed guideline will be issued by the DMT. This location will typically be a large building, with multiple rooms and standard living facilities. As long numbers are manageable, only nursing care needed is for a trained paramedical staff to visit twice a day and check temperature through non-contact thermometers of all persons. If the numbers swell, effective education sessions will be undertaken and all people will be asked to seek medical help if they have symptoms. An Electronic Decision-support System is being developed. Patients may be asked to call this number at the ‘Call Centre’ who will be able to deal with the eventualities.

Isolation : this applies to patients who have presented with symptoms at the hospital.The hospitalshould incorporate a triage area at the entrance of the hospital and separate those patients with fever or respiratory symptoms and send them to a specialized ‘Fever Clinic’.

This clinic will be operated by 1 doctor & 2 paramedical staff with standard level of protective gear (not full-blown PPE; the DMT will issue detailed guidelines about which staff at what level of the hospital require what level of PPE).

Patients with minor symptoms may be treated at home with strict advice for home quarantine; but those with moderate symptoms, who are aged above 40 yrs, or with co-morbid conditions should be admitted at an ‘Isolation Ward’. The isolation ward should have single rooms, with facilities for continuous supply of Oxygen, basic monitors, nebulisers etc. Symptomatic patients cannot be mixed with each other in an open-ward architecture (unless we are overwhelmed with admissions, in which case, there should be a minimum distance of 3 feet in between beds, preferably somewhat more). All staff working here (doctors, nurses, housekeeping etc. or anyone who will come in contact with the patient or things used by the patient) must have PPEs. It should be a dedicated team, with proper training given to them BEFORE the first patient comes in. This team should not be involved in any other part of the hospital.

‘Treatment of positive patients’ : it is expected that ALL patients in isolation facility would be tested for Covid-19 (subject to ICMR guideline which is being modified from day to day).

At the moment, the only testing facility is at Kolkata. As soon as a patient tests positive, the patient will be shifted to the ‘Treatment’ facility. This could be an ‘open ward’ architecture, as now we will be dealing with a homogeneous group of patients who are ALL Covid 19 positive and have no chance of internal transmission. ALL health workers (HCW) working at this facility must be selected and specially trained and provided with PPE (THIS IS TO BE ACHIEVED BEFORE THEY RECEIVE THE FIRST PATIENT; AND MULTIPLE DRILLS HELD). A small subset (about 5%) will require Intensive Carefacility.

Detailed documentation will be prepared by the DMT about the requirement at the ‘Treatment’ centre. Fundamental necessity is that of adequate supply of Oxygen – the hospitalis currently dependent on Type B cylinder where we could get somewhat overwhelmed if the mathematical modelling of projection of patients within the campus turns out to be correct.

For the last few days, I have been in constant touch with various companies and I think the best and quickest solution would be to purchase a small pre-fabricated manifold for a 15-20 bed ward and install this, along with an Oxygen Concentrator (this may be possible within 7-10 days from approval).

As per current government guideline, all Covid-19 positive patients will be transferred; but I have an apprehension that very soon the state’s resources will be stretched and we may not be able to do so. So, I would suggest that we do put in place at least 2 ventilators and deploy trained staff to operate those, just in case.

The fight against this virus will be won only through escalating our level of preparedness.

I have already established a Covid-19 facility at Salboni and have advised the governments of Odisha and IIT Kharagpur in setting up a few more. I am in constant touch with WHO and AIIH & PH senior officials who I might be able to enroll for the DMT if you decide to constitute one.

The specific ways I can contribute and would like to do so include –

1. Preparation of all manuals in detail.
2. Preparation ofthe Clinical decision-support system.
3. Online training of healthcare staff in Covid 19 techniques.
4. Arrangement of infrastructure at IITG Hospitaland help in purchase of all that is missing.
5. Any other.